Atrial fibrillation is the most common sustained arrhythmia in humans. An incredible worldwide effort from physicians, scientists and industry over the last decade has brought forth new insights and therapeutic tools. We are fortunate to have achieved a level of understanding about this complex disease that we can indeed cure some patients. While we proceed at full speed ahead looking for cures for the rest, we have taken this opportunity in the Medical Clinics of North America to reflect on how much we have learned and on the task that lies ahead. This issue opens with a historical perspective, discusses many of the clinical issues in the management of atrial fibrillation, such as cardioversion, anticoagulation and ablation, and concludes with the current guidelines for treatment and a view of the future.